Why Do I Feel Terrible Despite Being on TRT? (TRT Q&As)
Timeline
Timestamp
Topic
01:30
Why do I still feel terrible, bloated, tired, and unable to lose weight despite being on TRT?
A 31-year-old man with obesity, prediabetes, hypothyroidism, and low testosterone reports poor results from testosterone and HCG. Dr. O’Connor says the case needs a broader evaluation beyond testosterone, including the ABCDs™, CBC, iron studies, inflammation, glucose, thyroid treatment, mental health, and weight management.
A 31-year-old man with obesity, prediabetes, hypothyroidism, and low testosterone reports poor results from testosterone and HCG. Dr. O’Connor says the case needs a broader evaluation beyond testosterone, including the ABCDs™, CBC, iron studies, inflammation, glucose, thyroid treatment, mental health, and weight management.
06:10
Are my abnormal blood tests dangerous while I’m using Sustanon and Deca?
A 37-year-old man reports elevated hematocrit, estradiol, creatinine, and liver markers while using Sustanon and Deca. Dr. O’Connor explains that the numbers require context and recommends evaluating blood pressure, cardiovascular risk, CBC and iron studies, kidney and liver health, androgen doses, and other potential contributors.
A 37-year-old man reports elevated hematocrit, estradiol, creatinine, and liver markers while using Sustanon and Deca. Dr. O’Connor explains that the numbers require context and recommends evaluating blood pressure, cardiovascular risk, CBC and iron studies, kidney and liver health, androgen doses, and other potential contributors.
10:10
What blood tests should I get if my kidneys feel sore and I have low energy despite being on TRT?
A long-term TRT user reports kidney soreness, fatigue, weight gain, and feeling as though his testosterone is no longer working. Dr. O’Connor recommends a comprehensive evaluation including CBC, iron studies, metabolic and kidney testing, urine studies, blood pressure, and potentially a renal ultrasound and nephrology evaluation.
A long-term TRT user reports kidney soreness, fatigue, weight gain, and feeling as though his testosterone is no longer working. Dr. O’Connor recommends a comprehensive evaluation including CBC, iron studies, metabolic and kidney testing, urine studies, blood pressure, and potentially a renal ultrasound and nephrology evaluation.
13:50
Why am I getting nipple sensitivity again after gynecomastia surgery while using testosterone and Deca?
Dr. O’Connor explains that high androgen exposure and Deca’s progestogenic activity can contribute to recurrent nipple sensitivity even after gynecomastia surgery. He recommends reducing androgen exposure rather than relying on long-term aromatase inhibitor use and discusses the possibility of residual breast tissue responding again.
Dr. O’Connor explains that high androgen exposure and Deca’s progestogenic activity can contribute to recurrent nipple sensitivity even after gynecomastia surgery. He recommends reducing androgen exposure rather than relying on long-term aromatase inhibitor use and discusses the possibility of residual breast tissue responding again.
17:49
Do my TRT blood results look good after switching to smaller, more frequent testosterone injections?
A 37-year-old man asks about his testosterone, free testosterone, estradiol, and prolactin after changing from Sustanon every two weeks to smaller frequent injections. Dr. O’Connor explains that hormone levels are moving targets depending on injection timing and emphasizes keeping androgen exposure low when elevated estrogen and other downstream effects develop.
A 37-year-old man asks about his testosterone, free testosterone, estradiol, and prolactin after changing from Sustanon every two weeks to smaller frequent injections. Dr. O’Connor explains that hormone levels are moving targets depending on injection timing and emphasizes keeping androgen exposure low when elevated estrogen and other downstream effects develop.
20:00
Why does HCG restore my sexual function for only a few days before it stops working?
A 29-year-old man with a history of steroid use and persistent sexual dysfunction reports a dramatic but temporary response to HCG before his testicles shrink again and the benefits disappear. Dr. O’Connor discusses possible downregulation and loss of responsiveness, the need for drug holidays in some cases, and the complexity of trying to maintain HCG’s sexual benefits long-term.
A 29-year-old man with a history of steroid use and persistent sexual dysfunction reports a dramatic but temporary response to HCG before his testicles shrink again and the benefits disappear. Dr. O’Connor discusses possible downregulation and loss of responsiveness, the need for drug holidays in some cases, and the complexity of trying to maintain HCG’s sexual benefits long-term.
Video Summary
This mailbag discussion focuses on questions about adjusting testosterone dose during therapy. It explains that not every symptom change requires a modification and that timing and context matter. Dose decisions are framed as deliberate clinical steps rather than reactive fixes.
A central portion discusses how labs, symptom trends, and consistency guide adjustment decisions. The episode emphasizes avoiding frequent changes that increase variability. Patience and observation are highlighted as part of responsible management.
The closing segment reinforces testosterone therapy as structured long-term care. Proportional responses, monitoring, and expectation alignment are emphasized. Hormone therapy is positioned as benefiting from stability rather than continual recalibration.
Drug Callouts
Drug
Description
Testosterone
Testosterone is an androgen hormone used therapeutically to treat confirmed testosterone deficiency and related symptoms. In this mailbag episode, testosterone therapy is discussed in relation to dose adjustment decisions.
Condition Callouts
Condition
Description
Testosterone deficiency
Testosterone deficiency is a clinical condition characterized by low circulating testosterone levels with associated symptoms. It is referenced as the indication for therapy while emphasizing dose management.
Key Takeaways
- Dose changes should be guided by trends rather than isolated symptoms.
- Frequent adjustments can increase variability.
- Labs support context-driven decisions.
- Patience improves interpretive clarity.
- Structured monitoring supports safer outcomes.